Journal of Invasive Cardiology

Data from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) project demonstrate that 14.9% of the overall and 10.3% of the non-CABG population underwent transfusion during hospitalization for NSTE-ACS.⁹ There was significant variation in transfusion rates across sites, which may be partly explained by the controversy surrounding the role of blood transfusion in the management of anemia and bleeding among patients. There are no randomized clinical trials of transfusion strategies specifically in patients with ischemic heart disease; however, there are observational studies that suggest a strong association between transfusion and a higher risk of recurrent MI as well as death in this patient population.^9,20 Although patients undergoing transfusion have a higher baseline risk and experience worse unadjusted outcomes (e.g., 30-day mortality) compared with those not undergoing transfusion,⁹ transfusion increases this risk by two- to four-fold after adjustment for these differences.^9,20 Thus, clinicians should make every effort to minimize the risk of bleeding and blood transfusion through careful dosing of adjustable anticoagulants and management of patients during invasive procedures.